Articles: patients.
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There is much more to study and learn about prevention of anesthesia complications and how technology may improve the safety and outcome of anesthesia. Large trials have never shown that a specific hemodynamic monitoring technique improves outcome. ⋯ Through all the controversy one thing remains constant: the response to information coming from monitors depends solely on the person administering the anesthesia. Aids to practitioner vigilance probably can never be proved to possess independent benefit, but their role in improving practitioner performance cannot be argued.
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The patient state index (PSI) is a clinically validated measure of the effect of anaesthesia and sedation. The PSI is calculated via a proprietary algorithm by a high-resolution 4-channel electroencephalograph (EEG) monitor after advanced artifact rejection. ⋯ The EEG monitor, initially called the PSA4000, is also the SEDLine monitor, the newest generation of the device. The SEDLine system provides the clinician the option of storing and downloading patient data for future use as well as monitoring bilateral brain function and symmetry with a density spectral array (DSA) display.
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Acta Anaesthesiol Scand · Jul 2005
ReviewAftermath of an adverse event: supporting health care professionals to meet patient expectations through open disclosure.
An important element of how adverse events are handled is effective communication between health care providers and patients and their families. This review addresses the main questions: What do patients expect in the aftermath of an adverse event? What is known about the practice of open disclosure? How can organizations support health care providers in the aftermath of an adverse event, both professionally and personally? Patients clearly expect open disclosure to include an explanation of what happened, an apology for harm done, that appropriate remedial action will be taken and an explanation of what will be done to learn from the event and to prevent recurrence. Research has found that open disclosure is not very common although the ethical duty to disclose is widely acknowledged. ⋯ Significant commitment is required from health care organizations and managers to develop frameworks for open disclosure to occur, to assure its quality and to support health care providers in this process. Organizations also need to address the emotional needs of health care professionals in the aftermath of an adverse event. Last but not least, adequate systems for debriefing and incident analysis need to be in place to learn from adverse events and to avoid recurrence.
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Reg Anesth Pain Med · Mar 2005
Review Case ReportsDealing with difficult patients in your pain practice.
Pain patients can be difficult. They can provoke negative feelings of frustration and anger among clinicians and damage the doctor-patient relationship. ⋯ Issues of comorbid psychopathology, hostility, suicidality, aberrant drug behavior, and chronic noncompliance are discussed. Specific recommendations are also given of the best ways to manage patients with difficult behavior.
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A systematic review of qualitative and quantitative studies. ⋯ Patients have explicit expectations on diagnosis, instructions, and interpersonal management. New strategies need to be developed in order to meet patients' expectations better. Practice guidelines should pay more attention to the best way of discussing the causes and diagnosis with the patient and should involve them in the decision-making process.